Public Bill Committee

[Mr. Christopher Chope in the Chair]

Clause 153

Health services and social services: local involvement networks

John Pugh: I beg to move amendment No. 226, in clause 153, page 109, line 28, after ‘of, insert ‘access to’.

Christopher Chope: With this it will be convenient to discuss amendment No. 227, in clause 153, page 109, line 34, at end insert—
‘(d) notifying relevant transport bodies of any problems or improvements in access to care services.’.

John Pugh: As we enter the last rounds, we come to two quite significant amendments that would introduce issues of access and patient journey times to the matters to be considered by local authorities.
There are major omissions from clause 153 as it stands. A big issue for patients is not so much the delivery of services but the reconfigurations that are going on throughout the land, which the Government say will continue. Medical changes might also dictate that the reconfigurations continue. Financial pressures and the payment by results system will also ensure a degree of change. The general policy is to move care from the secondary care sector to the primary care sector and to centralise around centres of excellence. All of those factors bound together will produce a rearrangement of the health landscape in any one area. That has specific consequences for patients, because it affects their journey paths to services.
The journey to health care is often the very core or essence of people’s anxieties. People do not doubt that they will receive quality services once they get there, but they sometimes wonder how easy it will be to get there or, in the case of emergency services, whether they will get there in time. It is particularly an issue for the elderly, the socially excluded and people with children. The matter is at the core of debates about community hospitals, of which there have been many in this place, and of debates about urban and suburban reconfigurations, but it is often ignored by the health establishment. Sometimes, public transport authorities and highways authorities seem to live in a parallel universe to health authorities, given the limited amount of consultation and interaction between them.
 In my area, health services were reconfigured and services were moved from one hospital to another as a result of an extensive medical report, the Shields report. In it, Professor Shields said that such changes would create problems in accessing services, but that those were not problems for the health service—in other words, the problems could be deposited elsewhere. However, the changes have created problems for patients, and if there is to be a genuine and useful patient consultative body, it must take those problems on board.
 I understand that we are not going to have a stand part debate on the clause, so I wish to make a few general comments. At the heart of the proposals is the fact that, as far as I can see, no lever of power is taken out of the hands of the quangos and given to the community. We are going to have a long and extensive debate about the shape of the consultative body, but the fact of the matter is that the lever of power will remain almost exclusively in the hands of the quangos. I am sure that the Minister will understand what I am trying to say if I compare the almost platonic model on which health service governance is based, whereby governance is left to the experts and is not given or handed to the people, with the local authority governance model presented in the Bill. The Department for Communities and Local Government allows the public, through electoral and other arrangements, to have an involvement in emergency services, transport, social care and so on, but when it comes to health services, the approach is altogether different.
 I accept that the Bill attempts to put a certain amount of power in the hands of the public in so far as they will be consulted a little bit more. The Government are inching in the right direction; but they are only inching—they are moving very slowly. With the amendment I am trying to persuade them to go a little further. They can take a step by accepting the amendment, which asks them to take on board a serious concern for patients—the transport arrangements for getting to health services.

Phil Woolas: I thank the hon. Gentleman for moving the amendment in such a constructive way. He seeks to amend clause 153, which requires local authorities to make contractual arrangements to ensure that local involvement network functions can be carried out in the relevant areas. Establishment of host organisations is relevant to that. It might also assist if I remind the Committee that the clause will oblige local authorities to facilitate LINKs organisations.
The clause refers to all local authorities, but clause 159 limits the applicability of the clause to those with social services responsibilities, and only English authorities are relevant. In plain English, therefore, we are not concerned with districts. The LINK function definition which the hon. Gentleman seeks to amend is 
“promoting, and supporting, the involvement of people in the commissioning, provision and scrutiny of”
health and social care services. The hon. Member for North-East Bedfordshire observed that that should include monitoring as well, and I have undertaken to consider that, because the Government see the sensein it.
A second, and important, part of the function as defined involves
“obtaining the views of people about their needs for, and their experiences of”
health and social care services. An additional element involves making those views known to
“persons responsible for commissioning, providing, managing or scrutinising local care services”
and making of reports and recommendations to such people about how provision of health and social care services could be improved. As has been mentioned, a regulation-making power is needed to allow the Secretary of State to amend, add to or delete such activities. However, my hon. Friend the Member for Bedford will have something to say about that later in the debate, and we shall be able to consider it then.
 The Government believe that it is vital to promote user involvement in health and social care, because it is only through seeking out the views and experiences of those who use the services that we shall be able to improve them. In fact, it is not the only way, but it is a necessary way—if not a sufficient one. It is also a way to make services more user focused, which is what the hon. Member for Southport desires—to look at things not from the point of view of the provider, but from the point of view of the patient or would-be patient. In summary, the clause requires that councils with social services responsibilities make contractual arrangements—we shall debate later with whom, and how—to ensure that there are means by which a local involvement network activity can be carried out in the council’s area.
 We are debating amendment No. 227, which thehon. Gentleman addressed directly, and amendment No. 226, which would broaden the range of responsibilities. The hon. Gentleman mentioned the Highways Agency, I believe, or was it highways authorities?

John Pugh: Highways authorities.

Phil Woolas: I am sure that all hon. Members would echo his views in that respect. It is important that such public sector agencies work together and in partnership. However, although I do not disagree with the purpose of the amendments, I do not believe that they are necessary.
Amendment No. 227 would add the activity of
“notifying relevant transport bodies of any problems or improvements in access to care services.”
 That is unnecessary because the clause provides that the key organisations that will receive reports and recommendations from LINKs are the commissioners, providers, managers and scrutineers of care services. LINKs will certainly collect information that is important for other organisations too, and there is nothing in the Bill to prevent them from passing that information on. LINKs, in the first instance, could—I would argue that they should—report any access problems to the commissioner of those services so that it can take account of those matters in its commissioning decisions and when it influences other local partners through mechanisms such as local strategic partnerships. LINKs will also be able to refer matters of concern, such as accessibility, to the relevant overview and scrutiny committee. Therefore, I agree with the intention of the hon. Member for Southport, but argue that it is already covered.
Amendment No. 226 similarly aims to extend the activities to explicitly include obtaining people’s views on their access to services. However, that is already captured in subsection (2)(b), which refers to
“obtaining the views of people, about their needs for, and their experiences of, local care services.”
A key part of obtaining people’s views on access to services will be the extent to which their needs have been met and how they have experienced the services they have received. My hon. Friend the Member for West Ham gave a very good example of the practical impact of that. In a survey of her community, it was pointed out that access to the local GP was not being used to the extent that the health service expected; instead, patients were travelling a further distance to use the hospital. When asked why that was the case, people pointed to the blindingly obvious fact that there was a bus route to the hospital and none to the GP. Access to services, as the hon. Member for Southport says, is the type of issue that Members of Parliament deal with, but it is more commonly dealt with by local councillors. The example of my hon. Friend the Member for West Ham graphically illustrated that point.
The point that the hon. Gentleman makes about access to services has been well heard. It is part of the rationale behind the framework that we have created to solve those problems. That is why I believe that the clause as it stands covers the desirable consequences that the hon. Gentleman seeks. I ask him, therefore, to consider withdrawing his amendment.

John Pugh: I thank the Minister for that clarification. I think that what he is saying is that the phrase “experiences of” in subsection (2)(b) includes experiences of getting to the services as well as going through the services. Therefore, I am prepared to consider withdrawing the amendment for the moment, but I will seek further clarification on the matter from other colleagues at a later stage. However, what I would emphasise is that the problems are often unsolved in particular areas, and it is not clear who owns the problems. I have sat in debates in which members from Hertfordshire, for example, have complained about the reconfiguration of their services. They have drawn attention to the fact that when the health service directs some patients to Watford, it is completely unaware of problems caused by football traffic, for example—although that problem might be reduced next season.
 My point is that the problems are genuine and widespread, but when they do occur, it is not obvious whose job it is to resolve them. There can be a certain amount of buck passing in which the health authority puts the onus on the transport authority to produce a better bus service, for example, but the transport authority then says that it was not advised properly when the reconfiguration first went through. The holes in the Bill as it stands leave certain problems unaddressed. None the less, for the moment, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Alistair Burt: I beg to move amendment No. 197, in clause 153, page 109, line 34, at end insert
‘and to patients and the public’.
 The amendment relates to the powers of LINKs to publicise their work. There is concern that, if the Bill does not specifically mention that, there may be a supposition that all the LINKs do is to report to the commissioners because that is all that is mentioned. The Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), sent the Committee a helpful note on how she envisages LINKs with work. Indeed, in the draft policy statement, under the section entitled “Make reports and recommendations and receive a response within a specified timescale”, the right hon. Lady sets out what she intends to put in regulations. The draft states:
“The regulations will specify the LINks’ power to make reports and recommendations and will specify...who they can make them to—NHS and social care commissioners and providers in their geographical area”—
and nothing else.
The straightforward reason why the matter has not been mentioned might be that it is intended that the work of LINKs should be published and, if they want to bring something to the attention of commissioners and others, they should feel perfectly free to make that information available to the public. However, that is not in the Bill. If regulations are tight and specify not a permissive power regarding to whom the LINKs may make submissions, but a restrictive power so that they make reports and submissions only to certain bodies, patients’ ability to make clear to the public what is going on will be stifled.
The purpose of the amendment is to draw out from the Minister a clear statement either that there will be an expectation that LINKs and other bodies will report to the public; or that the Government will make that clear by putting it on the face of the Bill. Naturally the accountability of LINKs to the public needs to be tested, which is a good reason for publication, but the accountability of the bodies that they are looking into on behalf of patients should be clear to the public. I should be grateful if the Minister will explain what he thinks and say whether my concerns are unnecessary or whether it would be helpful to have such a provision in the Bill.

Patrick Hall: I rise to speak to amendment No. 182. If you will allow me, Mr. Chope, I too wish to make some wider remarks—

Christopher Chope: Order. Amendment No. 182 is not being discussed. We are discussing amendmentNo. 197.

Patrick Hall: Sorry, I was looking at last week’s selection list.

John Pugh: I endorse amendment No. 197. Sometimes patient groups are not properly representative of patients as a whole. By having them refer back to the wider patient groups, there would be a more representative function.

Philip Dunne: To add a rider to that, will the Minister clarify whether ambulance trusts would be included in the scope of local services? As ambulance services have been regionalised, there is in relation to access to acute hospitals concern about whether ambulance services are capable of being scrutinised by LINKs through this process.

Phil Woolas: The answers to the questions are yes, yes and yes. Ambulance trusts are covered, as is clearly desirable. The hon. Member for Ludlow makes the point that they cover a wider area than the local authority. It is, of course, up to the contractor bodies to make arrangements across the area of the ambulance trust. That is one reason why we need to be flexible. Similarly, a primary care trust might extend beyond one of two local authorities. In some cases, local authorities are not coterminous with PCTs. The Government, through their consultation on the reconfiguration of PCTs, faced criticism in respect of that exercise and chopping and changing, but part of our objective was to ensure greater geographical coterminosity between PCTs and local authority areas. My colleagues at the Department of Health consulted in anticipation of the policy that we have now brought forward. That is joined-up Government, although it did not look like it at the time. Seriously though, there is 80 per cent. coterminosity in England now. The answer to the point that the hon. Gentleman made about ambulance trusts is yes.
 The hon. Member for Southport makes the valid point that part of the objective for LINKs and health scrutiny is to involve not only patients, but those who may have been or still are patients. The hon. Gentleman’s point is important. However, I shall resist the amendment and will give my reasoning for doing so in a moment.
 It is clearly desirable to achieve what the hon. Member for North-East Bedfordshire is talking about. We expect that LINKs will publish such information in a way that makes it available to its public. Clause 158 sets out the process for the annual report, which it is desirable to include in the Bill. It is quite common, as hon. Members will know, for us to receive hefty envelopes containing annual reports that Parliament has required various bodies to produce. We want to provide those bodies with flexibility, so we do not wish to go further and specify the information and the process of providing it, but we do expect them to provide the relevant information and we intend that that would be covered in the notices and guidance that we issue.

Alistair Burt: No one would want an already bulky document at the annual general meeting to include all the individual reports that LINKs may have wanted to produce on their work during the year. The draft note from the Minister, which we have seen, does not include reference to publication. If the Minister took back to his colleagues the suggestion that the draft guidance should make explicit the need to make those reports public, that might do the job.

Phil Woolas: That sounds sensible and desirable. I give that undertaking to the Committee.
 By talking about heavy, burdensome documents, the hon. Gentleman has pre-empted the second paragraph in my speaking notes, so I shall not bore the Committee any more than I have done. I ask him to consider my remarks and to withdraw the amendment.

Alistair Burt: To have wrung a concession from the Government at seven minutes to 11 makes this an early champagne moment. We will bank that, as Anne Robinson would say, and move on to the next amendment. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Alistair Burt: I beg to move amendment No. 198, in clause 153, page 109, line 35, leave out subsection (3).

Christopher Chope: With this it will be convenient to take amendment No. 182, in clause 153, page 109, line 36, leave out ‘or omitting any of’.

Alistair Burt: The amendment would removeclause 153(3), which states:
“The Secretary of State may by regulations amend this section for the purpose of adding to, varying or omitting any of the activities for the time being specified in subsection (2).”
 That is a wide power that would effectively render neutral the discussions that we have just had about what LINKs should do, because, no matter what the Bill says, if the Secretary of State decided in future—perhaps after complaints from health authorities or others—that the powers given to LINKs are too extreme, then instead of returning to the House to agree primary legislation to change the Bill, the Secretary of State may, by order, simply remove those powers.
It is not just we who are concerned about this provision. I should like to quote two other bodies. In relation to subsection (3), the London Network of Patients’ Forums said in its briefing:
“This is far too wide. It gives the present or any future Government of any political complexion the power to abolish all involvement of people in commissioning, providing or scrutiny of local care services...without further recourse to Parliament. It was probably drawn by an overzealous draftsmen”—
I hear hon. Members say, “Surely not.”—
“but it reminds one of the original proposal to abolish the Community Health Councils...without replacing them. It was parliamentary pressure that caused the Patients’ Forums to be created as a replacement of the CHCs.”
 The London network is plainly concerned, but the Commission for Patient and Public Involvement in Health is, too. I draw the Minister’s attention to its briefing, which specifically raises concern about this clause:
“Clause 153(3) gives the Secretary of State power to make regulations to add to, omit or vary any of the activities above for the time being, whereas the legislation establishing Patients Forums...gave the Secretary of State no power or limit to vary the functions of PPI forums.”
It continues:
“The Bill does not give the Secretary of State power to make regulations on any other important matters, such as membership or governance rules and would therefore have no ability to intervene in the future, without amending the primary legislation, even if significant problems or concerns rose on such matters.”
Why is the power in the Bill? What is the reason for the concerns of the CPPIH and of members of patients forums? I should be grateful if the Minister explained why this wide-ranging power is in the Bill?

Patrick Hall: As you can see, Mr. Chope, I am following the Committee’s orchestral score a little more carefully now, although I was in danger of being distracted by yet another reference to a champagne moment by the hon. Member for North-East Bedfordshire. They keep clocking up. I hope that careful note has been taken of that so that we are rewarded at the end.
I was asking you, Mr. Chope, if I might range a little wider, as you have kindly allowed others to do, as I would like to acknowledge the good and hard work of patients forums’ members up and down the land. I have met a number of patients forums’ members through the all-party parliamentary group on patient and public involvement in health, assisted by the Commission for Patient and Public Involvement in Health. We recently held two sessions, one in Parliament in October and another just outside this building last January, to enable patients forums’ members to have their say and to express their hopes and fears about LINKs. The week before last, I also had a meeting with members of the Bedfordshire patients forum.
It is remarkable that there are threads and strong issues held in common right across the piece. I was struck by the energy and commitment of the people. They are volunteers and they contribute a great deal of time and effort. They are also very well informed and their views are worth listening to. That is the purpose of having an all-party group—to hear what people outside this House have to say. Indeed, that is also the basis of our job as Members of Parliament. Those people wish to serve the community for the common good and have sought to do so through the mechanism of patients forums. Whatever happens, we must take great care not to lose the commitment, energy and qualities of people who are understandably a little concerned about what will happen. There is a role, and there will continue to be a strong and growing role, for patient involvement in health, whatever mechanism is designed to deliver it.
 We should approach this matter from the viewpoint of the ground upon which we stand and build from where we are. There is a lot of perplexity among patients forums’ members about their abolition—it is indeed abolition that we are talking about. Although no one at the Bedfordshire forum meeting said that they loved what is happening, I was none the less encouraged to find that the forum had prepared a paper, a copy of which I will pass on to Ministers, especially those in the Department of Health, expressing the view that although the page is a little blank—the canvas is sketchy and almost empty—that provides an opportunity to help to shape what will happen. I thought that that was an optimistic and positive view.
 I hope that my hon. Friends fully understand patients forum members’ disappointment, particularly with the decision to abolish the forums, and that Ministers will welcome their positive suggestions and others’ about the road to take. My approach to part 11 will be to seek through a number of probing amendments to encourage debate and thought and to encourage the Government to help us to colour in the many gaps on the canvas, because it is difficult to identify the architecture.
 Last Thursday during our afternoon sitting, the hon. Member for Hazel Grove sought to gain the sympathy of the Committee by admitting that he had been too busy to have his lunch. I said nothing at the time, but at lunch that day, I was given for the first time a copy of a long-awaited draft model contract between local councils and host organisations, together with a restricted set of papers dealing with how LINKs will function. The bundle made reference to promised guidance on governance and “engagement activities” that will be published only when the Bill receives Royal Assent. That rich larder of information served as my lunch. I did not eat it, but I did not have time to eat anything else. I am sure that I will now have some well earned sympathy, and perhaps another notch up on the champagne later.
Although some time has elapsed since Thursday, I must confess that I have not read those documents from cover to cover, although I have had the opportunity to examine them more. Looking at them, I have no doubt that the Government have strong ambitions for LINKs, that hosts will play a strong role and that there will have to be a lot more consultation before the architecture is built more clearly. There is a lot more to be done. It is important to consider the documents in the context of the amendments. Nearly all the amendments moved were prepared and tabled before we knew of the documents. None the less, our debate will be important.
I will also fall for the assumption made by the hon. Member for Hazel Grove that the words on the face of a Bill mean what they say—that the English used means what I understand English in common-sense terms to mean. That is why I am pressing amendment No. 182. I shall assume, as subsection (2) says, that the purpose of LINKs is to promote and support
“the involvement of people in the commissioning, provision and scrutiny of local care services”,
to obtain
“the views of people about their needs for, and their experiences of, local care services”
and to make such views known in
“reports and recommendations...to persons responsible for commissioning, providing, managing or scrutinising local care services”.
 That seems absolutely fine. I do not know how else one could describe in a nutshell what a public involvement organisation should do, whatever one calls it. That is fine, but as has been mentioned, subsection (3) risks undermining that function entirely. The Conservatives wish to delete the subsection altogether, but I think that that would be too restrictive. It is sensible to be able to vary or perhaps add to the measures. Indeed, when they are established, LINKs might wish anyway for a mechanism to do so without going through all kinds of complicated, time-consuming bureaucratic procedures.
 However, to allow the Secretary of State to omit any of the activities in subsection (2), even if they must consult on that omission, seems inappropriate. It goes too far. It could send a negative or destabilising signal at a time when people need to be reassured that there will be a firm foundation for patient and public involvement in health. My amendment seeks to reduce that uncertainty. I look forward to the Minister’s response.

John Pugh: As I understand the amendments, they are very different. Amendment No. 198 would ensure that the powers defined in the Bill could not be varied by the Secretary of State, while amendment No. 182 would just ensure that they could not be varied to omit any of the LINKs’ existing functions or roles. The ministerial position, in contrast to the amendments, appears to be to reserve the right in subsection (3) for unfettered varying.
I am in favour of the Secretary of State’s having some power to add to and to refine LINKs’ powers. I do not anticipate that he would give LINKs extreme power, as the Conservative spokesman suggested—I think that, if the Government did that, we would be amazed—but there is clearly a drive in the Committee to understand what the variation might mean, given that no guidelines have been laid down on it. The most acceptable outcome, from the Liberal Democrats’ point of view, would be variation governed by certain guidelines and restrictions.

Bob Neill: I support my hon. Friend the Member for North-East Bedfordshire. I referred in our discussions last week to some of the concerns raised by my patients forum, and this is one of them. There was concern that part of the unspoken, hidden rationale was the feeling that successful patients forums had rubbed people the wrong way.
If patients forums or the proposed LINKs are to do their jobs properly, it will sometimes be necessary for them to deliver messages that are uncomfortable—uncomfortable for health service managers, for the Department and maybe for local authorities. They must be able to do so in the full confidence that, if their messages are uncomfortable—if they sometimes say things that are harsh but necessary—there will not be a tendency, as sometimes happens, to say, “Let’s get rid of this rather awkward, turbulent priest and be done with it.”
There is a suspicion at the moment that that is partly what has happened to the current patients forums. If they are to be successful in the guise of LINKs, they must have guarantees of independence. There is a concern about independence of funding, to which we can return later, and about how they will have the independence to inspect rigorously without being obstructed. There is also a concern that their functions should not be chopped and changed in a way that could at the very least emasculate their effectiveness.
I am sure that that is not in the minds of the Ministers here today, but who knows how such things will proceed? There are always pressures, and although I appreciate that the ability to remove the turbulent priest by statutory instrument is an improvement on Henry II’s method, the principle is just as unpleasant and inconvenient. If people are to have confidence in the volunteers whom we want to involve, surely they are entitled to know that the goalposts will not be changed as punishment for being effective and delivering harsh but necessary messages.

Phil Woolas: I am not sure that I like the Henry II example. I am searching the cellar for some champagne.
 I shall explain what the Government are trying to do in clause 153. The experience of the patients forums, as the Government acknowledge, was that their role and functions were too tightly prescribed in primary legislation. Changes in health that occurred more quickly than some might have expected meant that the forums were unable to adapt to fit the changing circumstances and their working environment as well as they and we would have liked. Therefore, it is important to retain the power to amend the specified activities. That is not unusual when establishing bodies. It will enable Parliament to adjust the role of LINKs on proposals from the Secretary of State when they are necessary to reflect changes in health and social care. I agree with the hon. Member for Bromley and Chislehurst in that we have to pass legislation for a sustained and unforeseen period, not only for circumstances as they exist. It is perfectly possible that new functions and areas of health and social care will come about as a result of technological developments, or as a result of localised changes and the devolutionary powers that health and social care services have.
I reassure the Committee that both Houses of Parliament will make the decision on future proposals, which will be subject to the affirmative procedure. Our intention is for LINKs to remain up to date, which is why we wanted subsection (3). As I said, it is not unusual that Parliament and the Secretary of State should retain such powers.
 The Committee has a problem with the word “omitting”. The intention of having that word in subsection (3) is to account for possible changes in local circumstances, or for functions that are carried out at the moment but which might not be necessary in the future. I was told, when I entered Parliament, that it was still illegal not to practise archery on a Sunday. I have always believed that post-legislative scrutiny should get rid of laws as well as build them up. That was the entirely honourable intention behind the word “omitting”. My hon. Friend the Member for Bedford and Opposition Members have identified circumstances in which the power may cause disquiet among the people that we are trying to encourage, but mention of Henry II is going too far.

Bob Neill: I am sure that the Minister has the genesis of a Henry V in him. Perhaps he will come a little further with his reassurances.

Phil Woolas: My general rule on kings is that if they were Lancastrians, they were probably good guys.
I agree with hon. Members in that there is a problem with the word “omitting”. However, we need the power to vary the specified activities subject to the parliamentary procedures to which I referred.
There is a slight difficulty in the wording of amendment No. 182. Should we accept it, the clause would not read properly because of the comma—a tiny, technical point, but striving for perfection is a good thing. The Government agree with the intention of amendment No. 182 as regards the word “omitting”. However, we believe that amendment No. 198 goes too far because, if accepted, the Secretary of State and Parliament would not be allowed to bring the measures up to date when circumstances require. There is also the issue of how LINKs will develop. They may be required for support functions such as training that are not prescribed but which may become necessary. I would like, with the patience of the Committee, to find a way of getting rid of the word “omitting” while making the Bill read well.

John Pugh: The Minister is clearly trying to tidy up and give assurances and all of the things that it is desirable for a Minister to do on such occasions, but he is suggesting that the Secretary of State will not usethe powers without the affirmative resolution of the House. If that is the case, why is there a problem with putting that in the Bill?

Phil Woolas: I am reliably informed that that is in the Bill—when I find it, I will let the hon. Gentleman know where. The hon. Gentleman made a fair point, but provision is made for the matter to be subject to the affirmative resolution.

Alistair Burt: Is the Minister suggesting that he will, in due course, introduce a new clause that will remove the word “omit”?

Phil Woolas: Yes, I shall do that. It will also remove the comma, so that it reads properly. I should also like to take this opportunity to ask the hon. Member for Southport to consider clause 170, which relates to the point that he made.
I hope that the hon. Member for North-East Bedfordshire will consider asking leave to withdraw the amendment.

Patrick Hall: Let me be the first to say it: yet another champagne moment—the second of the day!

Alistair Burt: Surely, it is a magnum moment.

Patrick Hall: I have not been counting as accurately as the hon. Gentleman.
I am also relieved about the comma, the least said about which in future, the better. My hon. Friend the Minister was going to deal with the comma and the omission. On reading clause 153(2) it is difficult to imagine how patient and public involvement in health and social care could be carried out by omitting any of the requirements. Powers on variation and flexibility are included in the measure. In view of my hon. Friend’s intelligent, generous comments, I shall not press my amendment.

Alistair Burt: I endorse what the hon. Gentleman said. It is a good moment for Bedfordshire all round, in respect of the clause and the Bedfordshire amendments. However, I should be grateful, knowing what the English language is like, if the Minister made it clear that there is no way in future that the term “variation” would be deemed to include omission. If he did so, that would deal with the point. In theory, “vary” could mean anything. I forget whether Committee debate can be used in the courts to indicate what was in Ministers’ minds at the time that legislation was passed or changed. I am clear what the Minister’s intention is, but it might be helpful if he said it.

Patrick Hall: There is always doubt, with the English language or any other language. I have checked the “Concise Oxford English Dictionary”, which defines “vary” as to change, make different, diversify and also to suffer change.

Alistair Burt: I am grateful to the hon. Gentleman. However, I would still find it helpful if the Minister made clear what we know his intention is.

Phil Woolas: “Vary” in law carries a different meaning and definition to “omit”. “Vary” implies changing from one thing to another, not simply stopping doing things. I will undertake to make that clear.

Alistair Burt: I am grateful. That tidies things up and deals with the main point of our amendment, which was to cover the point raised by the hon. Member for Bedford. With the Minister’s assurance, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Patrick Hall: I beg to move amendment No. 180, in clause 153, page 109, line 39, at end insert—
‘(4A) The Secretary of State shall make payments to each local authority that are in the opinion of the Secretary of State sufficient to cover the costs incurred by that local authority in making contractual arrangements specified under subsection (1).
(4B) Nothing in this section shall prevent a local authority making contractual arrangements under subsection (1) so as to ensure that the activities specified in subsection (2) are carried on to a greater extent than would be the case if the arrangements were to cost no more than the payments made available under subsection (4A).
(4C) The Secretary of State must send to the Comptroller and Auditor General within sixty days after the end of the financial year a statement showing the payments made to each local authority under subsection (4A) and the costs incurred by each local authority in making contractual arrangements under subsection (1).
(4D) The Comptroller and Auditor General must examine, certify and report on the statement provided by the Secretary of State under subsection (4C) and must lay copies of the statement and of his report before Parliament.’.
The amendment has a number of aims. It provides, first, that the Secretary of State should make available to local authorities sufficient funds to deliver effective local LINKs; secondly, that councils are welcome to be generous and to add to that sum if they wish; thirdly, that information about the funding made available to each local authority should be open to scrutiny by the public, councillors and Members of Parliament; and, fourthly, that local authorities should use the funding that is made available by the Secretary of State to support LINKs and hosts, not for other purposes. The amendment is designed to meet concerns raised by forum members and by others.
 Ministers have said, and it should be repeated, that patient and public involvement in health and social care will involve a vast number of people and organisations—not only the patients forum members. Concerns have been raised across the piece that, as is often the case, funding will be insufficient. Whatever the state of the economy or of the settlements for local government, local councillors—I have been one—always say that funding is insufficient. Unless things are nailed down there is a temptation to use funds for other purposes, and the fear is that the funding for LINKs will not be ring-fenced and could be used for other purposes. I accept that there might be more that is wrong with the amendment than merely a comma. It probably would not succeed in achieving ring-fencing, but its purpose is to generate a debate and probe the issues.
 A lot of the talk about costs is speculative, and I would appreciate some guidance from Ministers on the funds that might be made available. If that is too much to do now, perhaps the Minister could write to me later. All sorts of figures are being bandied around. For example, it is being said that community health councils cost, in their last one or two years, an average of £150,000 each. People have said that each LINK, and each host that sets one up, will get that amount, but I do not think that that can be correct, because there were many more community health councils than the proposed 152 LINKs. The amount that is currently spent on patient forums is also being mentioned. I believe that that is £26 million, which equates to £170,000 per new LINK. If the central costs of the Commission for Public and Patient Involvement in Health are added to that—I am informed that they are £1.5 million—the average figure increases to £184,000 per LINK. The commission itself estimates that an average budget of £400,000 will be required for LINKs to carry out the vast range of tasks that have been set for them—tasks that we have just discussed. That would produce a national total of more than £60 million.
Whatever happens, LINKs will not come cheap, and there will be high expectations of the new system. They will cost money, and people will want to see that money being used cost effectively. Whatever the amount is, it will all be needed for LINKs, and it will not be acceptable for it to be frittered away in other directions. The amendment is intended to avoid that.

Tom Brake: Does the hon. Gentleman agree with ring-fencing in principle? Is it the appropriate way for local government finances to be managed? I admit that it is an unlikely scenario, but I encourage him to consider a situation in which LINKs had worked so effectively—with embedding of processes in parts of the health service—that they were no longer required. The hon. Gentleman’s amendment would mean that there would have to be a certain amount of spending on them nevertheless. Will he consider that?

Patrick Hall: We may have a clue as to whether it is needed after a few decades of studying how the new system has worked. However, I find it difficult to imagine that there will cease to be a need for patient and public involvement in health and social care—I really do not see that need disappearing. Given the pace of change in the welfare system—technological, scientific, medical and in other ways—I envisage an increase in the need, rather than a decrease.
The principle of ring-fencing ensures that taxpayers’ money, which comes from the Government for these purposes, is delivered through local councils to host organisations. There is a specific purpose for the money and, in principle, I do not see any harm in ensuring that the money is delivered for that purpose. Ring-fencing is the sort of mechanism that has occasionally been used before to ensure that a job is done. The purpose of the amendment is to ensure that we have the opportunity to debate that matter and to hear what the Government are thinking.

John Pugh: We support the thrust of the amendment if not its actual fine detail. I think that it will be well received by treasurers of local authorities who are used to local authorities being given extra responsibilities and then being told by the Secretary of State that the cheque is in the post. Sometimes they have difficulty finding the cheque for the sum that they incurred when they took on the new responsibility. It seems to me that the hon. Member for Bedford is suggesting housekeeping measures that will have to be agreed to at some time anyway. It is really a question of how it is done and whether it is done by adding a schedule to the Bill, by making provision elsewhere in the Bill or by a Minister—or more probably a civil servant—on a Friday afternoon. I think that I prefer the hon. Gentleman’s solution to the problem.

Tom Levitt: Mr. Chope, I hope that you will give me licence to raise one or two points that might more properly be discussed on clause stand part. I will refer to the amendment, but I understand that it is not your intention to allow a clause stand part debate.
I would be grateful if the Minister confirmed for me that when the amendment refers to local authorities, that means local authorities with social services departments. In two-tier areas such as my own, that would be the county council rather than the district council.
 The Minister pointed out that approximately 80 per cent. of PCTs are now coterminous with local authorities. In my constituency, our PCT is one of the 20 per cent. that are not. In Tameside and Glossop PCT, Glossop comes under Derbyshire LINK, and the rest of the PCT area comes under Tameside metropolitan borough council’s LINK. In those situations, the local authorities and the LINKs must be obliged to talk to each other if they are discussing services and constituents who live in their area. That leads me to ask another question: if someone lives in Glossop, and therefore comes under Derbyshire county council and Derbyshire LINK, but uses a service in Tameside, which is within the same PCT but outside their LINK area, would they take their problem to the Derbyshire LINK, which covers where they live, or to the Tameside LINK, which covers the area where the facility is provided? In other words, are the inspections on behalf of the residents or of the facilities?
My final point relating to that and the amendment is that the administrative costs in those LINKs that are dealing with more than one PCT area will presumably be significantly higher than those in which there is a one-to-one relationship. Will the Minister give an assurance that where LINKs have to deal with more health bodies than would be the case in a coterminous situation, the additional funding will be supplied?

Philip Dunne: I share the concerns raised by the hon. Member for High Peak, particularly in relation to LINKs covering a relatively narrow geographical area. The issue that comes to my mind is of services that go beyond the scope of the general PCT. I refer here to specialist services. In my area, for example, the mental health service has been taken out of Shropshire County PCT and now comes under the South Staffordshire Healthcare Trust, which has responsibility not only for mental health services within South Staffordshire but also across the Prison Service. I understand that the trust looks after mental health services in more than50 prisons, including on the Isle of Wight. Has the Minister considered how a trust that develops activities way beyond its historic area will interact with LINKs? In particular, has he given consideration to how LINKs can fund their activities if they wish to go across boundary?
 Finally, I wish to ask the Minister from where will the funding come? As it is to come as a result of the Bill, I assume that it will come from his Department. Was the £26 million of PPI forum funding to which the hon. Member for Bedford referred a Department of Health budget? Can all local authorities be secure in the knowledge that the funding will be provided to them through their relationship with their own Department rather than from the Department of Health?

Bob Neill: I want to reinforce my hon. Friend’s point about prison medical services. I practised as a barrister in the criminal courts for 25 years and I sometimes had a great deal to do with the recipients of prison medical services, so that strikes a important chord. There is real concern among legal professionals, the judiciary and the probation service about the variable quality of medical services in prisons, how they are provided and their accessibility. There is a difficulty with transparency and patient voice in prison medical services. I do not expect the Minister to have an answer now, but I flag up the matter because it is of real concern, particularly given the linkage and the large number of people in prison who suffer from mental health problems.
There is concern about the difficulty in finding means by which we can keep up consistent pressure to improve the quality of services, especially when, for example, prisoners on remand may be moved from one institution to another and therefore come under the care of more than one trust as the provider. There is a complete lack of transparency and accountability in those circumstances. People in prison, by its nature, often do not have the constituency base to argue for them that there is in the general community.

Tom Brake: Last week, I visited a prison and saw its medical services. Does the hon. Gentleman agree that the cost implications for LINKs set up in an area with prisons are significant? The process of consulting prisoners will clearly be more challenging than consulting the public generally.

Bob Neill: Indeed—the hon. Gentleman is absolutely right. LINKs may not be the solution for prison medical services, but we must have something that will safeguard the interests of prisoners, either on remand or convicted, who are also patients. Inadequate treatment of a number of problems, particularly mental health, is sometimes a significant trigger in reoffending, as we all know. It is important that the matter is taken away and looked at and, perhaps before the Bill is discussed on Report, we can receive more assurance about how overview and scrutiny of medical services in prisons will be dealt with.

Phil Woolas: I thank hon. Members for their comments because they really show the value of Bill scrutiny. Many of the points that have been made and the questions that they throw up provide reasons why the precise prescription in the amendment is not desirable. I think that my hon. Friend the Member for Bedford accepts that. The arguments that have been made are very pertinent to the consideration of the Sustainable Communities Bill. In essence, we have heard the experience of Members of Parliament in the real world and how we have to adapt to that to make mechanisms work.
Members of Parliament make representations on behalf of their constituents to service providers that are sometimes at the other end of the country or overseas. They sometimes make representations on behalf of people whose last known address was in their constituency, but are now overseas or serving “at Her Majesty’s pleasure”, if I could put it that way. The arrangements are important and I am grateful to members of the Committee for raising them.
I confirm to my hon. Friend the Member for High Peak that we are talking about social services authorities. Two-tier district authorities that do not provide social services would not be covered. In consideration of his point about what we do in areas that are not coterminous, I was casting around for the most difficult example in the country; I then realised that it was Glossop in Derbyshire and in the same thought, realised that my hon. Friend the Member for High Peak was on the Committee.
Those Committee Members who know that part of the world will know that there is a natural community in the north-west of Derbyshire that pulls towards the Greater Manchester area in terms of travel-to-work arrangements, but that the rest of the constituency of Derbyshire pulls towards the rural and beautiful county of Derbyshire. Indeed, my hon. Friend’s mental health trust is shared with other local authority areas in the Greater Manchester area, including my own. Therefore, he raises a very good point.
The hon. Member for Carshalton and Wallington has raised the point about prison medical services. In those circumstances, other things being equal, the costs would be higher. That is why we believe that the mechanism of grant distribution should not be as tightly ring-fenced as my hon. Friend the Member for Bedford’s amendment would have it.
The amendments and the debates around this clause strike at the very principles that underpin local government funding. Promising the end of ring-fenced funding is an easy way to get a round of applause at the Local Government Association conference, as the right hon. Member for Witney (Mr. Cameron) discovered last July. It is a different thing altogether when one looks at some of the many functions that local government provides, especially under a regime of devolution and partnership working. In practice, one applies pragmatics to the deliberations. Local councils, as has already been said, will always present a gross bill for their new functions. In my experience, they have never presented a net bill of the savings as well as the new costs. I do not expect them to do so, but I always hope that they will. We therefore have to be wary in our implementation of the new burdens policy—a policy to which the Government are committed and for which, as has already been established, we do deliver the money.
We shall deliver the money for the LINKs function, but one has to be has to be realistic in preparing new burdens grants and ensure that that they are meeting net costs and not paying an invoice that has arrived from 150-plus local authorities around the country. I am not suggesting that treasurers would over-egg the pudding—they do not need me to suggest that. They put together the most ingenious, innovative reasons why every one is unique. Sometimes they are right—sometimes there are real needs, as described by my hon. Friend the Member for High Peak. It would therefore not be sensible to make legislation that precisely prescribed a mechanism that would result in, in effect, a blank cheque. On the other hand, it is entirely desirable that the functions are properly financed, both in their establishment and in their operation. Let me explain how we propose to do that.
 There are four parts to amendment No.180. The first proposes that a requirement be put on the Secretary of State to ensure sufficient funds are available to cover a local authority’s costs in its work to put in place contractual arrangements that enable the establishment of LINKs. The intention, as the Committee knows, is that the Secretary of State will make a grant to each local authority to enable it to fund its activities to procure a host organisation—those are the establishment costs—and subsequently to fund the activities of the LINK itself. We propose that the grant should be made under section 31 of the Local Government Act 2003. The grant will be explicitly targeted to provide funding for the purpose of making arrangements to establish a LINK. In relation to this part of the Bill, it is Department of Health money that I am spending on the champagne.

Robert Syms: I bet it’s cava.

Phil Woolas: We have better than cava in our Department.
 In making the grant, the Secretary of State will assess what levels of funding will be necessary for each local authority to cover its costs and ensure that there are sufficient funds to enable arrangements to be made to fulfil the activities set out in the Bill. The grant will go to the council in recognition of the fact that the council has a statutory duty to fulfil those activities, but will not prescribe the money too tightly, as ring-fenced budgets in other areas do. That will give the local authority some flexibility in making arrangements.
In anticipation of the new arrangements, we are working with local councils and with the Local Government Association, which is once again carrying out an essential function on councils’ behalf, to determine the costs associated with administering and monitoring contracts between councils and host organisations, which will vary according to the nature of the area and the local authority’s infrastructure. Funding will be allocated to local authorities according to a mechanism that takes into account factors such as variations in size and arrangements with health care-providing organisations. We believe that to put all that on the face of the Bill would create a self-fulfilling prophecy of complications and bureaucracy. At the end of the day, it would not give the taxpayer the best value for money.

Alistair Burt: May I ask the Minister to note that an issue about formula funding in health care and local authority matters is arising in rural and semi-rural areas? There is a concern that formula funding does not properly take into account some of the problems of such areas, such as distance and isolation. I am keen for him to indicate that any formula should take into account such issues, because there is a debatable point about how they are currently handled, and I want that to be noted.

Phil Woolas: The ears of my hon. Friend the Member for Wigan are twitching after that intervention. He represents Wigan and the metropolitan authorities and he is conscious that if I answer in the affirmative, the metropolitan authorities will get a smaller slice of the cake, other things being equal. That is the problem faced by any Government in distributing funds—a point that I urge hon. Members to raise with proponents of the Sustainable Communities Bill, as that fact of basic arithmetic seems to have gone missing. My answer is yes: sparsity is a factor in the proposed distribution calculation.
Hon. Members will point out the apparent differences between the health funding formula and the social care funding formula. Under the social care funding formula, we take into account the number of people over 90 in an area, but I believe that in health funding the cut-off age is 85. That represents a sensible policy relating to prevention and health. As health and social care are brought closer together, funding formulas must be rational and transparent. We all desire that. What we do not want to do in recognising the different pressures on different areas is to create a complicated formula, because complicated formulas are the enemy of transparency and accountability. They are also the enemy of a happy state of mind for Ministers for Local Government.

Patrick Hall: The formula, complicated or otherwise, is to do with the amount granted to a local council to set up hosts and LINKs. My question is not only about whether that amount will be enough, but whether the money will be used for the purposes for which it is allocated.

Phil Woolas: The answer is that yes it will. Special grants over and above the revenue support grant are often described as ring-fenced. When there is flexibility, the money is given in the expectation that a council will carry out a function. We do not prescribe and create a situation in which if x amount of money is given, it must be spent specifically on certain expenditures because there are different ways in which functions can be undertaken. For example, if one wants good use of buildings, one might enter into an arrangement with a health authority to rent one. Is the money involved to be accounted for by LINK, or should the accounting of it be proportionate to the fact that the building might be used by another part of the health and social care service, or by an independent tenant?
 The formula and special grant, under the 2003 Act, does not prescribe exactly; it meets the purposes that my hon. Friend, on behalf of LINKs and the people hoping to be involved, quite rightly outlined. Can we guarantee that the money given to a council will be passed on to LINKs, or does the fact that councils control the money give them sway over LINKs that may be detrimental to independent scrutiny and accountability? I give my hon. Friend the assurance that the mechanisms of the grant-making powers in the 2003 Act are designed to do the former. That is also why I teased my hon. Friend the Member for Wigan when he talked about the abolition of ring-fenced grants: there is a general predilection against them when one talks to local councils, and a general predilection in favour when one talks to pressure groups and charities.
 The 2003 Act provides for a mature way in which to fund councils, whereby there is an expectation that functions are delivered without the unnecessary bureaucracy that the present and previous Governments have imposed in the past.

Tom Brake: May I bring the Minister back to the subject of complex formulae? He expressed a preference for simple formulae. Do I take it from that that the presence of a prison will not influence the amount of funding for a LINK?

Phil Woolas: The most extreme example I can remember of an argument for change to a funding formula in social care involved a local authority, which said that because it had an above-average number of blocks of flats with an above-average number of stairs, it took social workers in the area longer to meet clients than elsewhere. The hon. Gentleman knows—we have debated this before—that formulae cannot be too complicated. I said simple formulae, not very simple formulae; that is important. The judgment will be based on factors such as the size of an area, the nature of the population, demographics and so on. It will perhaps also be determined by factors such as the one he mentions.
For the hon. Member for Bromley and Chislehurst, I can confirm that prison medical services will be covered by LINKs. LINKs will make representations about and will cover prison medical services on behalf of the patient, which is to say the prisoner, not the prison. Therefore, what matters is how many prisoners a local authority area has, not whether they are imprisoned in their local authority. I am certainly not going to suggest that some local authority areas have more people in prison than others, but hon. Members will be aware of the delicate balance.

Alistair Burt: I do not want to hold up proceedings unduly and the Minister may not be able to answer this question just now. Yarl’s Wood, which is the largest asylum detention centre in Europe, is in my constituency. It has had some issues relating to medical and health care. What provision is being made to ensure that detained asylum seekers and their representatives have access to health LINKs? I do not expect the Minister to have the answer at his fingertips, but I would be very happy to receive a letter on that in due course.

Phil Woolas: The hon. Gentleman is entirely accurate when he says that he cannot expect an answer to that question now. None the less, he makes a good point. Yarl’s Wood is in his constituency and for many years he has argued—very conscientiously in my view—on behalf of the asylum seekers or failed asylum seekers when it would be easy for him not to do so. I will give him an answer on that important point. I suspect that it will involve letters around Government and a flurry of activity, but he makes a good point.

Tom Levitt: I just want to make a helpful passing comment to the Minister. The issues being raised by the hon. Member for North-East Bedfordshire are not any different to those in respect of patient advice and liaison services. When an individual has a complaint that they want make, they use the PALS procedure. It is already established that PALS will take a complaint from anyone who lives within the PALS area.

Phil Woolas: My hon. Friend makes an important point, and it applies to many representative and advocacy bodies.

Bob Neill: I appreciate the spirit in which the Minister has approached the question of prisons, and I hear what he says about funding. My intervention also relates to access, which is a point my hon. Friend the Member for North-East Bedfordshire has raised as well. There is concern among the prison population in particular that prisoners can be transferred between a number of institutions and moved from the care of one trust that is providing for a number of prisons into the care of another. There is a long-standing concern about the handover of prison records to ensure continuity of treatment, medication and so on. Again, I appreciate that the Minister will not have the answer at his fingertips, but can we have some assurances in writing about how LINKs will work to ensure that there is scrutiny of the prison medical service, and about how prisoners and their families can get access? Their specialist advisers will need access as well because they may need the right medical reports to put before a court.

Phil Woolas: The hon. Gentleman makes a good and fair point. He will know also of the circumstancesin which a prison can commission a number of health providers. Even when the prisoner and patient isunder their jurisdiction, they are not necessarily in the same hospital. Therefore, I will comply with his request.
In proposed subsection (4B), it seems that my hon. Friend the Member for Bedford is aiming to allow local authorities to spend more on making contractual arrangements than the allocation provided by the Health Secretary. There is nothing in the Bill to prevent councils from making additional funds available for LINK activities. I hope that my hon. Friend willagree that the amendment is not necessary in that respect.
I can see what is being proposed in subsection (4C). It is a means by which a local council can be identified if it has chosen to use some of the funds provided on expenditure that is not LINKs related. As I have said, I think that it is right that local councils be able to spend funds in a way that best enables them to make appropriate arrangements. That they have to make the arrangements is what the Bill is designed to ensure.
When the Secretary of State makes grants to fund LINKs to local authorities, the amount of the grant is in the public domain. As it is a special grant, unlike the revenue support grant, it is possible to identify how much has been allocated. That is not the case for other items. The most recent example that occurs to me is the concessionary bus fare scheme, in respect of which money was put through the revenue support grant formula. It is not possible to identify specifically how much is being given in such cases, but it is possible in the present case, which is the reason for having chosen the funding mechanism that has been adopted.
It follows that local authorities will have to account for their monies, and the monies that they make available to fund LINK activities will be covered by the annual audit. LINKs will be able to say how much money local authorities made available to fund their arrangements, and they will know how much the Secretary of State provided. I imagine that they will be professional and vigilant in holding any diversion to account.
 The problem on subsection (4D)—my hon. Friend the Member for Bedford acknowledged it—is that the resulting process for arranging statements and national auditing might be too complicated. Money will be made available to local authorities, and they will be accountable. They will have to make decisions in line with the thrust of the Bill, which is designed to give greater local freedoms and flexibilities. The Government will ensure that grants are open and transparent, and LINKs will know how much money has been made available.
I believe that the Bill achieves approximately the right balance, and I hope that my hon. Friend the Member for Bedford and the Committee will agree.

Patrick Hall: I have listened carefully to the debate, and it has been helpful. My hon. Friend did not refer to the total sums that might be available, and I cannot quite understand that. There is a lot of speculation about whether that total will correspond to the amount spent on patients forums and on the commission, or be equivalent to community health council spending. Although the Minister might not be able to state the amount now, I hope that he will write to me to give a broad indication.

Phil Woolas: I apologise that I did not answer that question. The answer is that the amount is not yet known, because we are entering discussions with local authorities to identify their needs. There is an obligation to provide sufficient funding, however. The budget for the Commission for Patient and Public Involvement in Health for 2006-07 is £28 million. If the Bill passes, that money would be taken into consideration.

Patrick Hall: I thank my hon. Friend for that. I think that many of people’s understandable fears will be answered when people consider what he said about section 31 of the Local Government Act 2003 and the special grant nature of the money. Local councillors will also know that there will be a great deal of interest in such matters as the time approaches, and I am sure that they will wish to ensure that the process is properly handled and that others are watching. In view of all, that I am happy with my hon. Friend’s response, and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 153 ordered to stand part of the Bill.

Clause 154

Arrangements under section 153(1)

Alistair Burt: I beg to move amendment No. 199, in clause 154, page 110, line 15, at end insert—
‘(2A) A local involvement network must consist of—
(a) individual members;
(b) representatives of organisations; and
(c) mechanisms for participation of individuals in A’s area who are not members.’.

Christopher Chope: With this it will be convenient to discuss the following: Amendment No. 200, in clause 154, page 110, line 17, at end insert—
‘(3A) In making the arrangements, H must invite all members of patients’ forums in A’s area to become individual members of the local involvement network.’.
 New clause 16—Form of local involvement networks—
‘(1) The Secretary of State shall make regulations making provision in relation to the activities specified in section 153(2).
(2) The regulations shall in particular make provision as to—
(a) the appointment of members, categories of membership and governance,
(b) the minimum number of members,
(c) any qualification or disqualification for membership,
(d) terms of appointment,
(e) circumstances in which a person ceases to be a member or may be suspended,
(f) proceedings of local involvement networks,
(g) the discharge of any function of a local involvement network by a committee of the local involvement network or by a joint committee appointed with another local involvement network,
(h) the appointment, as members of a committee or joint committee, of persons who are not members of the local involvement network or local involvement networks concerned,
(i) the funding of local involvement networks and the provision of premises, other facilities and staff,
(j) the payment of travelling and other allowances to members of a local involvement network or of a committee of a local involvement network or a joint committee of two or more local involvement networks (including attendance allowances or compensation for loss of remunerative time).
(3) The regulations must provide that no less than half of the members of a local involvement network are persons who are members of or representatives of voluntary organisations whose purpose, or one of whose purposes, is to advance the interests of—
(a) persons for whom care services are being provided as specified in section 153(5), or
(b) persons who provide care for such persons, but who are not employed to do so by any body in the exercise of its functions under any enactment.
(4) The regulations may include provision applying, or corresponding to, any provision of Part 5A of the Local Government Act 1972 (c. 70) (access to meetings and documents), with or without modifications.’.

Alistair Burt: This group of amendments relates to the membership of LINKs. The Bill’s ambiguity on membership is an issue about which our consultation with forums and their members indicates concern.
Amendment No. 199 addresses a point that I hope can be quickly dismissed, which is that there is nothing in the Bill requiring LINKs to be comprised of real people, so LINKs could comprise an entirely virtual arrangement—a concept that is not unusual nowadays. The whole process could be undertaken not with individual people operating in a personal capacity, but by means of the web, or another virtual mechanism. Colleagues will remember that Elizabeth Manero and Sally Brearley of Health Link gave witness evidence earlier in our deliberations. A website could be a means of carrying out the activities of a LINK. Our amendments set out clearly that people should be involved in LINKs, but I hope that the Minister can reassure us quickly about such matters.
 The amendments also specify our concern about who might be on a LINK. On 8 February in Westminster Hall, I had a meeting with 23 representatives of individual patients forums throughout the country. It was organised by Ruth Marsden, the chair of the PPI forum for Hull and East Yorkshire Hospitals Trust and the lead member of the associated forums of London, Leicester, Rutland, Yorkshire, Humberside and Teesside. We had a good cross-section of members of patients forums in Westminster Hall that day. Their concern ranged across the board from the abolition of forums to the introduction of LINKs. I have referred to some of their worries in earlier debates and I shall be using them in future.
Two concerns were expressed about membership. They were worried that the membership of LINKs is moving away from pinpointing patients’ concerns and patient involvement with those members from a much wider group who have an interest in health services and social care services. The specific concern was that the views of patients will be swamped by the views of those representing professional organisations. A member of the forum from Dorset said at the Westminster Hall meeting:
“Dorset is an early adopted project for LINKs. There was a meeting in January. only two forum members were there. A few were other people, all outnumbered by loads of health care professionals.”
Individual patient representatives are worried that the new expansion of LINKs, which is full of the right wording about involving more people, actually means diluting the emphasis that is being placed on the voices and needs of patients. That is terribly easy to do in a health care context. We all know how easy it is to sit round a large table when those whose profession it is to talk and represent others daily can be intimidating for ordinary members of the public who do not do it very often. Even if they become skilled, they can still feel that they are in the presence of those who can make life difficult for them.

Tom Brake: Does the hon. Gentleman agree that individual patients, as we know from contact in our surgeries, often feel threatened about the presence of some professionals, especially if at some point they need to go back into the health service and perhaps encounter the same people about whom they wanted to make a complaint?

Alistair Burt: The hon. Gentleman is right. There is a further variation of what he said. It is worth noting and is serious enough for the Minister to have in mind. Also at the Westminster Hall meeting and in discussion with representatives of patients forums, the fact was raised that they receive a number of complaints and concerns from members of staff in hospitals and trusts. They find themselves a valuable sounding board for those who, for one reason or another, feel uncomfortable about voicing their concerns about what is happening in a trust through the formal trust mechanism because they might be identified. We all know how the world works: no one wants to be identified as a troublemaker or anything else. The involvement of health care professionals sitting round the table may make it less likely that the forums are used as a necessary safety valve by members of staff in the NHS to make their points.
As a separate point, there was great concern about the loss of expertise. Everybody mentioned the fact that it is not easy these days to get people to come forward to take part in mechanisms such as the patients forum. It took painstaking work to bring people on board. We have discussed people’s concern that the abolition of forums means somehow that their views and efforts have been cast aside—we might return to that point when we debate clause 160 stand part—but many forum members also mentioned the difficulty of bringing people on board and keeping them there.
Hence, amendment No. 200 would passport existing forum members to the new LINKs. They do not want to apply for positions to find that those responsible for setting up the new LINKs are picking out individuals and saying, “They may have caused trouble in the past, so we’re not going to put them on.” We have evidence from people who have been excluded from forums. There is concern about that, so amendment No. 200 would passport existing members of the forum.
I hope that the Minister will accept the amendment. When his colleague and counterpart the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), came before the Committee as a witness, she said that she hoped that everybody who was already a forum member would come forward to ask to be a member of a LINK. We could make her wish come true by removing an element of the application and simply bringing into the LINKs all those who are already forum members.
I have a point to make about numbers. Worcestershire patient and public involvement in health forum sent the Committee a note dated12 February that said:
“Meredith Vivian”—
a senior official at the Department of Health—
“is on record as saying that he envisages up to 1,000 people/organisations being involved in a local LINK. There are great risks with such a large body, particularly in decision making”.
I think that we all agree that once a body gets so large, it can be a great talking shop, but its ability to do something will be hampered. How large will the LINKs be? How will we get the necessary balance between involving Uncle Tom Cobleigh and all and forming a small group of people experienced enough to go into trusts and do the job that they are required to do? How easy will it be for trusts to say, “This body is too large and unwieldy, and there aren’t enough people with specific experience, so we won’t give them access to our premises because we don’t believe that they’ll be capable of doing the job”?
The issues are serious. If LINKs are too large, how will the training be done? Where will the funding come from for new, expanded LINKs taking in so many people? The figure was that 1,000 people in an area will have an interest in health and will therefore be eligible to join a LINK. How on earth will that number be restricted and made more manageable? Nothing in the Bill indicates it.
Having raised those issues, I shall mention one further point. I have looked at the evidence to the Select Committee on Health dealing with patient and public involvement in the NHS. This debate gives me an opportunity to say again how concerned forum members are that the Bill has been introduced when the Select Committee has not completed its deliberations on the very issues that the Bill deals with. If the Minister dips into the evidence, as I am sure he has, he will understand the reasons for it. I cannot claim that I have read every word in the extensive volume of written evidence to the Committee; I have not needed to. If he dips his thumb into a submission by virtually any forum, he will find a familiar range of concerns illustrated. I pick out two for reasons of time.
The first comes from evidence submitted by the Kettering general hospital forum. It says:
“If membership is too large, LINKs will be unwieldy and expensive and not good value for money.”
Evidence submitted on membership by the Kingston forum says:
“This is a very grey area. In order to prevent interest groups taking over, independent members should be a majority. Very unclear as to which voluntary organisations should be members—no definition of membership.”
If the Minister dips into this volume, he will find similar comments replicated all the way through, but at least they are public. Evidence has not been published from the Department of Health’s consultation process on a stronger local voice, in which information was submitted by forums. The Department of Health has not made available to this Committee, or to anyone else, information on the feelings of forum members. I close on that because I do not want to go on too long and we still have more clauses to come.

Robert Syms: Hear, hear.

Alistair Burt: However, we must make some progress on membership, as I am reminded by my hon. Friend, who is no doubt speaking for his colleague in the Whips’ mafia. My points are serious, how is it to be decided? How is this expertise to be retained? How are the individual voices of patients not to be swamped by those of professionals in the health service? In terms of size, how are LINKs going to be manageable? How is training—and funding for it—going to be available to ensure that people can do their jobs?
With those remarks, I hope that the Minister will feel that we are not simply raising a political issue but speaking very definitely on behalf of those people who make up the membership of these forums up and down the country and who are very concerned. I would be grateful for some reassurance at this stage, although I cannot say either that these amendments will not be pressed or that they will not reappear at a later stage in the proceedings on the Bill.

Patrick Hall: I echo the comments that the hon. Member for North-East Bedfordshire has made about much of our debate being informed by the views of patients forum members, as I said myself earlier this morning. Indeed, the amendments tabled in my name are inspired by discussions with patients forum members.
However, it is important to recall—and I think I have mentioned this—that matters of public involvement in health and social care are not only the property of patients forum members. I have thanked patients forum members for their excellent work and dedication, and for being so well informed. However, many others who are involved in local voluntary organisations and members of the public, particularly the latter, rarely, if ever, dip into these matters. Therefore, I commend the Government for trying to embrace them and givethem an opportunity to be heard. That raises many questions that are the purpose both of the amendments and the scrutiny under which this Bill is being placed today.
 New clause 16, tabled in my name, deals with regulations. The Bill, as drafted, does not allow the Secretary of State to make regulations on membership and governance of LINKs. The new clause provides the Secretary of State with those powers so that should there be concerns in the future about matters of membership and governance—which inevitably there will be up and down the land—he or she will not be able to intervene. It will be for others to resolve those matters. There is always a risk that if there are no national criteria—minimum standards—to avoid inconsistency in membership and governance arrangements around the country, there will be greater necessity to have recourse to the courts to deal with those matters. That is always open to people but it would be better if we made it necessary or at least closed down the number of opportunities or requirements to do it.
 Having no statutory basis for rules governing membership and governance might lead to a perception that the bodies that are so set up, are in some ways weaker than if those matters were dealt with on a statutory basis. I note that the draft documents were made available last week—the hon. Member for North-East Bedfordshire may not have had the chance to read them cover to cover any more than I have—none the less, their existence shows that the Government intend to address some of those matters. Page 4—from paragraph 221 onwards—of one of those draft “do not copy” documents touches on Government arrangements, but it is a very light touch. Presumably, as I said earlier, the intention is to consult before publishing guidance, but, as mentioned elsewhere in the documents, it will not be prepared until after the Bill receives Royal Assent.

John Pugh: What the hon. Gentleman is suggesting is entirely sensible. Perhaps we should regulate that body, but is there not a prior difficulty? We simply cannot identify what such a body looks like. And we cannot regulate what we cannot identify.

Patrick Hall: Indeed. That is why we are debating and probing those matters in Committee. Significant elements of the landscape and architecture might become clear to us later, but the plan is that the descriptions and guidance will not be made available until after Royal Assent. That is why I am raising those issues now. We have been promised detail after Royal Assent, but that will come too late for legislative scrutiny. We need a bit more detail now.
 I am hoping that my hon. Friend the Minister will be as helpful as he can, as indeed he always is, and provide an explanation. There are difficulties because it is not planned to make some things available until after the Bill has proceeded through Parliament. That raises one question: why can he not accept the new clause? Presumably, the draft policy documents and so on will deal with the same matters. Furthermore, what are his views on LINKs having a minimum number of members—a core or board as it were? Some or all of them could be checked by the Criminal Records Bureau. The hon. Member for North-East Bedfordshire referred to patients forum members—they are checked by the CRB. Making use of such people would have advantages for time and bureaucracy. However, they should be used only if they want to be made use of. They should not be compelled, which is possibly the implication of earlier amendments.
We need to ensure that LINKs have sufficient people to carry out their functions, which would mean having people checked by the CRB in that way. How does my hon. Friend the Minister think that we can ensure that potential conflicts of interest can be identified? For example, a voluntary organisation might want to be part of a LINK and to get a contract from the local council to deliver care services. That might make sense. However, how can we ensure that a LINK is not used by a local campaign that is very intense for a few months, whose members join and take over the LINK, achieve their one-off objective and then disappear again? Obviously, that is not the intention of the provisions, but we need to probe those matters and ensure that there is some protection to allow the LINK to continue with its main task as well as to take on board concerns raised by the public, as will happen now and then.
There are all sorts of questions, and all sorts of solutions. We have mentioned a core governing body, around which there could be a federal structure involving different people and organisations concerned with different topics, which could be opened up to greater numbers of people as needed. Will there be a requirement on LINKs to operate according to standards such as those advocated by the Independent Commission on Good Governance in Public Services? I have a few documents from the commission that set out some of the standards that it advocates. A number of questions have been raised today about those matters and it is important that they are answered or, at least, that the direction of travel is indicated so that we can be confident that the LINKs will achieve the Government’s ambitions.

Phil Woolas: Clause 154, which hon. Members are seeking to amend, deals with how a LINK is established by a council and how the host organisation is set up. Subsection (4) proscribes who cannot be involved in the LINK. It sets out who the third party is to support the LINK, and that the host organisation may not be the LINK itself. We are talking, therefore, about three bodies. The first is the local authority that commissions and contracts with the host. The second is the host organisation, which may be a voluntary body. In response to later amendments, we will debate what cannot be a host organisation. Thirdly, the clause describes how a LINK can be established.
If I was looking for a populist headline—and I have never knowingly not done so—I would say that we are scrapping a £28 million quango and giving the money to local voluntary groups so that they can hold their health and care services to account. [Hon. Members: “Hear, hear.”] Thank you. I am convinced that if the hon. Member for North-East Bedfordshire had said that, Opposition Members would have said “Hear, hear.” Often, Members listen not to what is being said, but to who is saying it—but that is a debating point.
 The clause enables the local authority to make payments to the body that hosts the LINK and provides its administrative support. It also requires it to make arrangements that include provision for annual reports, which I have mentioned before. The amendments relate directly not to the contracted arrangements in clause 154, but to what is being contracted—what its function is, and how we can ensure that there are regulations to set boundaries for its activities.
At this point, there is a difference in opinion. The Government intend LINKs to be flexible enough to fit the circumstances that work locally, and free, as far as possible, from central control. That is partly because we want to ensure that they are independent, and are seen to be so, and partly because it is a devolutionary measure and therefore the necessary regulation—I am not talking about formal regulations—should be subject to different mechanisms. We intend to give each local authority with responsibility for social services guidance on and procedures for how the contracts should be drawn up.
The Government believe that it is vital that any system supporting user and public involvement is independent from external control, either from the health service and social care, or from political influence. LINKs will be established at the level of local authorities but will not be run by them. The clause makes it explicit that the local authorities will not host them directly. That is important in ensuring their independence. It is intended that the host organisation for each LINK should be procured through a tendering process. We are putting no limits on what type of organisation can perform this role—although there are some limits that we will come on to—but we think it likely that voluntary or community sector organisations will be well placed to demonstrate the local knowledge essential successfully to undertake this contract.
The host organisation will be required to use its funds to support and promote the activities of its LINK. It will spend the funds as the LINK’s governance structure directs. We come, therefore, to the points that hon. Members made in their amendments about how such arrangements can be delivered—I shall not use the word “controlled”, because that would have an unfair implication—and how we can ensure fairness, probity and so on. The Government take the view that LINKs should not be subject to diktat from the centre and we therefore want flexible arrangements. The means of influencing the arrangements would therefore be the contract between the local authority and the host, as well as the guidance that is issued.
 I therefore return to the point that I made on a previous amendment: the experience of patients forums was that the legislation was overly prescriptive and limited their ability to adapt to local needs or changes in circumstances. For example, the statutory nature of membership has limited the diversity of their membership and their ability to involve a wider range of people, although that is not at all to devalue their work.
That goes to the heart of the point that the hon. Member for North-East Bedfordshire made in moving his amendment. He seeks to protect LINKs from being influenced by professional bodies and perhaps organised infiltration, if I can use that emotive phrase.
 Alistair Burt indicated dissent.

Phil Woolas: The hon. Gentleman does not like that phrase, and the Government certainly do not. My argument, however, is that too narrow a definition of membership will not allow the public as a whole to be involved. The draft contract and the guidance therefore contain the idea that not only individuals, but voluntary organisations should be involved. We are trying to harness the vast knowledge, energy and benefits that individuals and groups can bring to the health and social care services. Let us imagine all the support groups and informal and formal networks that exist in our constituencies—the stroke associations, diabetes associations and disabled users’ organisations. A whole range of people and voluntary organisations can therefore become involved in LINKs.

Patrick Hall: I understand what my hon. Friend is saying about vast numbers of individuals and groups becoming more formally involved with LINKs, but he must be sensitive to the strongly held view among many patients forum members up and down the land that they have already established such links—if I can use that term—and that their forums’ constitutions and set-ups have not prevented them from making a vast range of contacts with local voluntary organisations. I am not saying that that is the case throughout the country or that the situation should not be improved on, but my hon. Friend must be aware that there are people out there who think that they are already doing much of what he says.

Phil Woolas: That is of course the case, which is why evolution, and our debate last week about how to describe these things, is important. However, we should not be too prescriptive or centralist, and we should recognise—this is an important point, which came out of the contribution by my hon. Friend the Member for High Peak—the different natures and health needs of different areas. The statutory nature of membership has limited diversity, and we want LINKs to be more flexible to reflect the nature of their local communities. We do not want, as new clause 16 does, to prescribe details of membership such as the proportion of members who should be individuals or voluntary organisations.
My hon. Friend the Member for Bedford is right to ask whether LINKs are covered by the good practice and probity models. Of course, they are statutory institutions, and interests must be declared in accordance with standards in public life, under the Nolan principle. Conflicts of interest are important, which raises the question of what people do if the charity or voluntary organisation is a service provider and an advocate, as is often the case. That is why it is important that that point is dealt with.

Alistair Burt: I do not want this essential point to be lost. As the hon. Member for Bedford said, nothing that currently happens in the health service prevents the various organisations and representative bodies that the Minister has spoken about from being involved with their local health service and making all the representations that they need to make. In addition to the access that they already have, a distinct patient voice exists in the forum. However, the new LINKs do not add anything to the representative organisations’ ability to do their job and they remove the mechanism for the distinctive patient voice to be heard on its own. That is the members’ fear. If there is no provision to ensure that, say, individual patient members constitute a majority of LINKs, that voice will be lost. The fear out there is based on the concern that this grit in the oyster can be uncomfortable. If the patient voice is subsumed in a larger body, it will be diluted and eventually lost. That is the reason for pressing for the distinctive patient voice, which will not be heard in the larger LINK proposed by the Government.

Phil Woolas: I understand the concern that the hon. Gentleman has expressed on behalf of some of the patients forums. I said at the beginning that there is an honest disagreement here. Judging by the evidence that has been given, there is certainly fear in patients forums that that voice would be diluted. However, large numbers of people do not feel that they have access to advance their point of view. Organisations that are often loosely based and without professional back-up, and which often do not have knowledge of or access to computers, are facing the daily struggle to care for family members—and they have to consider the range of health and social care provision. Those people are not often minded to be involved in formalised membership organisations.
Our approach provides the flexibility to ensure that local areas can have the best of both worlds and that, through the guidance and the draft contract, provision is made for the establishment of the sorts of rules that the hon. Gentleman mentioned, under which the number of members and the board would be prescribed, as would the different functions of LINKs, through which there may be a focus on the patient experience of transport access, as the hon. Member for Carshalton and Wallington said. The LINKs might want to consider the provision for patients with a certain condition, such as stroke victims, and how health and social care could cope with them. They might wish to look at a local hospital’s catering provision. That broader flexibility allows the LINKs to have the best of both worlds.
One has to be realistic about fears that the patient’s voice would be lost. There is the voice of the patient in general, which is the voice of the public, and there is the voice of the patient in assessing needs and experiences, which this part of the Bill addresses. In a debate on an earlier clause I said that this is about the interface between participation and representative democracy. Prescribing how constitutions, rules, standing orders and structures should be made would not achieve the objectives that Committee members wish to be achieved.
Amendment No. 200 seeks automatic transfer for forum members. I hope that I will not be interpreted as being anything other than supportive and appreciative of what has been done, but to prescribe terms of membership in that way would, again, take away flexibility. Forum members can become members of LINKs, and we will encourage them to do so. I imagine that in many cases they will need no encouragement. However, I recognise, as in the evidence, that there may be individuals who feel that their work is not being valued and that they do not want to take part in LINKs, which we would not at all want to encourage.
At heart, there really is a disagreement as to what we are trying to do, which is why I feel unable to serve any champagne. I believe that the points made in local areas will come to fruition through the contractual arrangements agreed and through the obvious necessity to balance participation against probity and fairness. Automatic transfer would cut against practicalities and against the idea of a bottom-up structure instead of a top-down one. I hope that those who expressed their desire for devolution—such as the hon. Gentleman who is about to intervene—will support my point of view and not the amendment.

Tom Brake: I prefer, as the Minister said, the bottom-up approach. However, given the diversity of the LINKs that will no doubt emerge, would he reflect on how it might be possible to ensure a national view of what is happening in those diverse LINKs?

Phil Woolas: That brief intervention takes us down an avenue that I think is covered elsewhere in the Bill, but the hon. Gentleman makes an important point. My answer is to call on Parliament, because that is Parliament’s job in part. He has a serious point; the Bill does not prescribe for a national LINKs, although it does not take away the possibility—or the probability. Because of the overlap of boundaries—the High Peak or Glossop point, as opposed to the Bedford point, if I may put it that way—in many areas such arrangements will need to be put in place. However, Mr. Chope, I think you would stop me if I strayed down that road. I give way, very finally—

Alistair Burt: The Minister has forgotten one part of the argument, which was the business of whether or not a LINK is a virtual body or one of a different sort. The clause says that a local involvement network is either to be “a person” or constituted by “(b) any other means”. I understand that there was a discussion about this during oral evidence to the Select Committee on Health; the two chief architects of the policy, Harry Cayton and Meredith Vivian, appeared to differ in their views on that important question, unable to decide between them whether the question should be left to local discretion or whether a LINK must have members. Would the Minister enlighten us as to precisely what “(b) any other means” might mean? Is it the intention of the Government that there should be virtual LINKs in some areas, rather than real people doing a real job?

Phil Woolas: I have to correct myself in two ways. First, it is not logical to be very final—one can be final or not final. I apologise. Secondly, I congratulate the hon. Gentleman on his powers of scrutiny, because there is indeed an “or” in there. Under the enlightened, modern, devolutionary legislation, setting up a virtual LINK is possible. That is not going to happen, but it is technically possible. LINKs could be carried out virtually, but that is clearly not our intention. The Bill allows for some flexibility, but I cannot imagine circumstances in which a LINK would be exclusively virtual. Thanks to the geography of certain areas, there might be advantages in the procedures, and we would want to ensure that there was fair access to such virtual arrangements. In any event, I congratulate the hon. Gentleman on his powers of scrutiny in discovering the “or” between paragraphs (a) and (b) of clause 154(2).

Alistair Burt: This provides a fundamental difference between us. I have listened carefully to the Minister’s explanations, but I do not think that they do the job of satisfying the many people who are profoundly concerned about the way in which the Bill is going. Let me make it clear that I shall withdraw the amendment only because I intend to return to the matter and to vote against the abolition of the forums, which comes up later in the Bill, and that covers the debate that we are having. I am not willing to divide the Committee, because that takes time and we have other things to do, but I am not satisfied with the answers, nor do I think that those outside this place will be. I shall come back to the matter in other discussions, including that on clause 160 stand part. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Alistair Burt: I beg to move amendment No. 201, in clause 154, page 110, line 17, at end insert
‘and who does not commission or provide local care services’.

Christopher Chope: With this it will be convenient to discuss the following:
Amendment No. 183, in clause 154, page 110,line 17, at end insert—
‘( ) In making arrangements, A may select as H either the National Health Involvement Network or such other person who in the opinion of A is able to deliver such an arrangement under section 153(1) so that it meets the general duty as set out in section 3 of the Local Government Act 1999.’.
Amendment No. 184, in clause 154, page 110,line 27, at end insert—
 ‘( ) The arrangements must provide that a local involvement network is provided with the staff, premises and resources that are necessary in the opinion of A for the local involvement network to carry on in A’s area activities specified in section 153(2).’.
New clause 15—National health involvement network—
‘(1) There shall be a body corporate to be known as the National Health Involvement Network to exercise the functions set out in section 153(2) to (5).
(2) The National Health Involvement Network has the following functions—
(a) advising the Secretary of State, and such other bodies as it may consider appropriate, about arrangements for promoting the involvement of people in the commissioning, provision and scrutiny of care services;
(b) representing to the Secretary of State, and such other bodies as it may consider appropriate, and advising him and them on the views in England of people about their needs for, and their experiences of, care services;
(c) representing to the Secretary of State, and such other bodies as it may consider appropriate, and advising him and them on the views of local involvement networks in England on their activities as respects section 153(2);
(d) facilitating the coordination of the activities of local involvement networks;
(e) advising and assisting local involvement networks in England;
(f) setting quality standards relating to any aspect of the way local involvement networks exercise their functions, monitoring how successfully they meet those standards, and making recommendations to them about how to improve their performance against those standards;
(g) promoting the involvement of people in the commissioning, provision and scrutiny of care services;
(h) such other functions in relation to England as may be prescribed.
(3) The Secretary of State shall by regulations make further provision in respect of the National Health Involvement Network and these may include such matters as status, powers, membership, appointment, staff, payments to, accounts, audit and reports.’.

Alistair Burt: This amendment is intended to ensure that those who can set up a LINK do not include people who will be involved in commissioning health services—that is to say those who are not named in clause 154(4). Because health services are now commissioned by more than just the statutory providers with which we are familiar, it has to be made clear that those who commission or provide local care services privately cannot also host a LINK. That is the purpose of the amendment.

Patrick Hall: If I had caught your eye on the last set of amendments, Mr. Chope, I would have asked my hon. Friend the Minister about the points that he has just made on the guidance on governance structures that he plans to make available after Royal Assent. Would he consider making available, as the Government have helpfully done on the draft contracts, an advance copy or outline of that guidance, so that we can get answers on certain matters?
 New clause 15 seeks to do something to address an issue that is frequently raised by patients forum members and others in the context of LINKs. That is the absence, to which my hon. Friend has already alluded, of a national body. The new clause would introduce such a body to serve local involvement networks. That would constitute the rebirth of a quango, so would be another opportunity for my hon. Friend’s press office to launch a populist campaign against it. The role of a national body would be to promote co-ordination, to share work, to improve communications between LINKs, to provide information, to organise training and support for LINKs across the country and, in so doing, to achieve the efficiencies and cost-effectiveness that 152 separate organisations would struggle to achieve.
It is important to share information and improve communication among organisations across the country, because many issues are not just local. Many health and social care issues are regional and national in nature, and it might make sense for local examples to be considered and reflected upon in the national context. Some things are best done from the viewpoint of a national dimension.
For example, under the present organisational system of commissioning, patients forums have recently carried out two national surveys into hospital bedside telephone services and hospital catering. These surveys, known as Fair Talk and Food Watch, were assisted by the existence of a national organisation—the Commission for Patient and Public Involvement in Health—which advised participating forums on how to conduct a survey, and how to collate and to publish its outcome. As I understand it, a similar survey is being undertaken this month by patients forums in England into patient dignity on hospital wards.
The telephone service exercise asked hospital patients and visitors about the cost of making outgoing phone calls using bedside telephone equipment. That certainly highlighted an issue of national concern, yet it was done in local areas up and down the country. The survey found widespread unhappiness with the high cost of calls, and that work contributed to the Department of Health patient power review group’s examination of those matters. A national body would also assist in scrutinising decisions that have a regional or national dimension, of which, as we know, there are many in the national health service.
Given time, it is true that, in the absence of a national organisation, LINKs would themselves want to develop mechanisms to communicate across the regions and nationally—and that might be sooner rather than later. I think that my hon. Friend the Minister was alluding to that a few minutes ago. A membership body is an alternative approach, but that does not exist yet, and in order to set one up the component members need to have enough resource to contribute to it. Although I am not certain of this, there is a question mark over whether a voluntary membership body that is not set down in statute is the weaker for it.
 However it is dealt with, whether in the Bill by setting up an organisation, or by a grassroots-up membership body, it is vital for LINKs to have a national voice. I do not see how LINKs can be at all effective unless that develops. The national health service is going through radical change, to which the Minister already referred. That internal reconfiguration is partly based on medical and scientific improvements, as well as the need for reform. For some, that is presented as a threat; it is certainly controversial. Yet while it has the potential to deliver better health services, what is required at every step of the way is for as many people as possible to be informed—that is, not only seeing what is happening in their towns or villages, but putting that into the wider context of their region or country. Every area is, or will be affected by that.
Patients forums are already engaged in these matters and, later, LINKs will continue to be. They will have to be deeply involved—and they must be, if the voice of the public is to be heard while being informed. While much of that work will rest upon local context and knowledge, one cannot address these matters unless there is a wider dimension. Indeed, the driver behind much of this comes from the Department of Health, through strategic health authorities; therefore, it goes beyond the local straight away. There needs to be scrutiny on a wider geographical basis than is envisaged by the 152 LINKs dealing with these things independently. It is important to plug the bigger picture into the local network of LINKs, and I hope that the Minister will take that point fully on board.
I have tabled two other amendments. Amendment No. 183 is dependent upon new clause 15 being accepted and there being a national body. It would allow a local authority to enter into a contract with the national body in order to act as the host of a LINK, should that be the best way of doing it. In some parts of the country there may not necessarily be a suitable local voluntary organisation to act as a host. There may be some that are capable of doing it. It is also possible that such organisations may already be contracting with the local authority to deliver social care, for example. The amendment simply offers that option.
Amendment No. 184 touches on the point that the hon. Member for North-East Bedfordshire raised earlier in giving a general view of these matters. Its purpose is to give LINKs physical, rather than virtual form. In the draft document that was made available last week, there was a reference in paragraph 4 on page 8 to premises and venues for meetings. But that is in a section dealing with hosts. The document says that hosts should have premises, which should exist. It does not go on to say anything about the LINK. Because of the way that that is written—I confess that I have not read the document from cover to cover—there is a danger that LINKs might be regarded as secondary to the hosts.
The hosts will have an office, but LINKs might not have to. Hosts will look after the LINKs budget, too. The LINKs might not have a bank account, I suppose. There are a number of issues here that I look to the Minister to address. If some of them entail looking at that document and writing to me, I will be happy to accept that. He may not have read it from cover to cover over the weekend, missing breakfast, lunch and dinner in order to do so.

Phil Woolas: It would be breakfast, dinner and tea where I come from.
One of the criticisms that members of Committees often make of Ministers is that we are against something on the ground that it was not invented here. I find myself in the interesting situation that, although my Department is not the author of these policies, in preparing for the Committee I have a duty to consider whether I agree with the policy. [Interruption.] My hon. Friend—

Alistair Burt: What goes beyond a magnum? Is it a Methuselah moment?

Phil Woolas: We are not getting anywhere near jeroboams.
I am amazed by the cynicism of members of the Committee and the idea that Ministers would not consider whether they agreed with the policy. The more I have thought this policy through over the past few months, the more I commend it to the Committee. This is a way that we believe we can have participation in these affairs without adopting a top-down approach. There is some consistency here. When we debated the clauses on the Valuation Tribunal Service, we said that we did not wish to set up by statute a national body of members of tribunals. The Valuation Tribunal Service would be national—the civil service of the tribunals—but we did not think that it was right to set up on a top-down basis a national body of members of tribunals. Such a body would exist and would be an important part of the function of tribunals, but it would be created from the bottom up.
 Similarly, if the LINKs wish to establish—and I imagine they will—a regional or national structure, perhaps to examine specific issues, I am sure that that will happen. However, to prescribe it on a top-down basis would lead to the accusation that the Government are creating quangos, and a public belief that the body in question is not independent of the state or Government.
If we are as a country to improve participatory democracy we must ensure that relevant bodies are not only independent but seen and believed to be so, so that the people who make their views known do not think that they must persuade the men and women in suits in the statutory bodies, but can instead access the organisations in question. There is a genuine difference. I believe that in practice regional and national groups will be established for the sharing of experience and findings. Nothing in the Bill prevents that, and there is indeed some encouragement from the Government in the relevant policy area for such proper help for LINKs. The Department of Health has recently contracted with a consortium led by the university of Warwick to provide advice and guidance on patient and public involvement. The NHS Centre for Involvement will perform some, not all, of the activities that are listed in new clause 15—in particular providing advice and good practice on patient and public involvement and reporting to the Secretary of State on how patient and public involvement is working.
We shall go on to debate the future of the Commission for Patient and Public Involvement in Health and I respect the remarks made by the hon. Member for North-East Bedfordshire on his last group of amendments; I think that it is clause 160 that gives us the opportunity. In any event LINKs are, as we have discussed, very different from patients forums, and to establish another body like the commission would be to set up an organisation not best fitted to the job that LINKs members would want to do. We are clear that there will be many local bodies able to provide the support needed by LINKs. Procurement will be through an open tendering exercise and the bodies will need to show that they have the qualities necessary to perform the role that is being contracted. Funding a national corporate body—even if such a body were necessary centrally—would represent a major diversion of funds that are needed at local level. I am sure that there will be no shortage of voluntary and community-sector organisations ready and willing to bid for the job of supporting LINKs. We certainly would not want to fund another body to perform that role when the capacity, local knowledge and familiarity with health and social care services is already available.
 Amendment No. 183 would provide local authorities with the power to decide whether to choose the national health service health involvement network that would be set up under new clause 15, or an organisation that the local authority believed to be well placed and equipped to do the job. I have already spoken about the suggested national health involvement network, and I agree that local authorities should be able to choose the organisation that they think is best equipped to carry out the functions of the host of a LINK. We are clear that local authorities should be left to make those decisions themselves. That is precisely why we are giving them the money and freedom to make the assessment of the necessary arrangements themselves. I do not believe that the amendment is necessary, because, by providing the funds, we are telling local authorities “Over to you” and leaving it to them to get the best organisation for the job.

Patrick Hall: I have listened carefully to my hon. Friend’s response and, not only today but every day in Committee, we are treated by him to some careful, sometimes amusing, but always honest reflection on matters. Today for the first time—

It being One o’clock,The Chairmanadjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at half-past Four o’clock.